Kevin Drum - June 2011

Via Felix Salmon, here's a fun new tool to play around with: the World Top Incomes Database. For example, here's a chart showing how the top 1% are doing in America vs. six other rich economies from around the world. Pretty good job, rich Americans!

You can create your own charts too. Just click here and then click on "Graphics." It's fun for the whole family — assuming your family is really wealthy, anyway. For the rest of us, at least it's free.

One more go-around on assisted suicide. Ezra Klein writes that he was unpersuaded by Ross Douthat's column on Monday condemning the practice:

But for all that some of the arguments for physician-assisted suicide are convincing, this article by Ezekiel Emanuel continues to give me pause. Emanuel shows that unbearable physical agony is almost never the reason patients give for seeking euthanasia.... Depression and other forms of mental distress — which are, of course, a sort of pain — are by far the more common motivator.

Emanuel also worries that the option of euthanasia will lead to worse care for the dying, and perhaps even subtle coercion on the part of loved ones and medical professionals who can no longer bear to see a patient suffer, or, more worryingly, can no longer afford to treat their suffering....That may seem alarmist now, but give euthanasia 15 or 20 years to become commonplace, and abuse, or at least overuse, is much easier to imagine.

I want to make a couple of points, one practical and one a little more philosophical. Emanuel's piece is 14 years old and I don't know if he's changed his views in the meantime, but on its merits I didn't find it nearly as persuasive as Ezra did. On a practical level, Emanuel argues that the experience of the Netherlands, which effectively decriminalized assisted suicide in the early 80s, demonstrates that not every physician follows the rigorous rules that have been set up to insure that assisted suicide is available only to those who genuinely want it and are of sound mind. But in fact, the numbers he cites are fairly small and not especially troubling. Only about 1% of Dutch deaths are assisted, hardly a tidal wave; most violations of the law are minor; and there's very little evidence that there's any serious level of abuse going on. It's trivially true that no human set of rules will ever be perfect, or perfectly followed, but falling short of perfection is a poor argument against how the Netherlands handles assisted suicide. In fact, the evidence suggests that they've done quite a good job of policing themselves on this front. If you don't want to die, nobody in the Netherlands is prodding you to do it anyway.

On a more philosophical level, the bigger issue here is the existence of a slippery slope: once assisted suicide becomes widely accepted, doctors and loved ones might start coercing dying patients into accepting it. It would be foolish to pretend that this an entirely ridiculous concern, but there's a good general rule to follow when you think about slippery slope arguments: does the slippery slope work with or against human nature? The former are far more dangerous than the latter.

For an example of the former, think about the torture of terrorist detainees. If we allow it in a few cases, is that likely to lead to a slippery slope in which we torture more and more prisoners? I think that's a real concern: millennia of human history demonstrate that jailers routinely torture their prisoners unless there are extremely strong, bright line rules against it. It is, unfortunately, pretty universal behavior If you break the taboo against it, you unleash that dark part of human nature, and once unleashed there's a very stong likelihood that it will feed on itself and get continually worse. That's why keeping this hard-won taboo in place is so worthwhile.

But what about assisted suicide? If it's legalized and becomes accepted, will it lead to doctors and family members trying to get rid of old and dying patients? In some cases, yes: the world is full of bad people, after all. But how likely is this to become a widespread problem? Not very, I think, because it flies against everything we know about human nature. Hollywood potboilers notwithstanding, family members don't generally want to kill off fellow family members, and that goes double for actively killing off parents. There are always going to be a small number of cases where this happens, but with even minimal safeguards in place it's simply not likely to ever become a major problem.

So the arguments against assisted suicide still seem weak to me. What's more, as with all proposed policy changes, you need to ask the question: compared to what? Will there be abuses of assisted suicide? Of course. This is the real world we're dealing with. But our current system of caring for the elderly already features massive, gruesome, systemic abuses. These abuses aren't hypothetical, they're real. The chances that a properly constructed assisted suicide regime would produce worse results strikes me as slight.

When Evan Bayh announced he was retiring from politics because the Senate had become a disfunctional pit of partisan rancor and he wanted to be "engaged in an honorable line of work," I didn't really believe him. Still, signing up with a private equity firm and then Fox News was a little more blatant on the cashing-in front than I expected. And now Andy Kroll passes along word that the other shoe has dropped:

Bayh has signed on with one of the most corporate-friendly, anti-environment shops in all of Washington, DC: the US Chamber of Commerce. According to an internal memo penned by Chamber president Tom Donohue, Bayh, along with former Bush White House chief of staff Andy Card, are now part of the Chamber's anti-regulation messaging team, doing "speeches, events, and media appearances at local venues."

The Chamber's hiring of Bayh, a big name in Washington circles, will only help its efforts to delay or kill new regulatory legislation in Congress....Bayh and Card, the memo says, will help the Chamber push this pro-corporate agenda in Washington and beyond.

Fine. Bayh is tired of living like a peon and wants to make some money while the making is good. And the best source of money for an ex-Senator is the bottomless checkbook of the U.S. corporate sector and its cheerleaders.

Like I said: fine. But no more sanctimonious speeches and op-eds, OK? I really don't think I could stomach that.

Caught in a maelstrom of his own making, Representative Anthony D. Weiner saw his support on Capitol Hill crumble after he admitted having inappropriate online exchanges with women. A brash and talented New York politician with many admirers on the left, but few close allies, he suddenly finds himself alone on a hostile stage.

No sooner had Mr. Weiner delivered a startlingly abject admission and apology — carried live on television Monday from a circuslike news conference in Manhattan — than top Democrats on Capitol Hill began distancing themselves from him and his behavior..... Nancy Pelosi of California.... Steve Israel of Nassau County.... Others said it would be impossible to support Mr. Weiner given the outrageous things he had admitted.

....Then there was the fact that his confession had occurred, in the words of one top Democratic Congressional official, a week too late. “It’s hard to trust in an individual who already lied,” said the official, who like others interviewed insisted on anonymity because of the sensitivities surrounding the matter.

Is this the way Republicans normally act? It seems like they're usually much quieter about this stuff, making a few pro forma comments about bad behavior and the need to pray and reflect, but basically sticking by their fellow sinners regardless of what they've done. Is that right? Or am I just imagining it? Republicans have obviously abandoned colleagues before, but it seems like it takes longer and it's the exception rather than the rule. Look how long John Ensign lasted.

David Brooks argues today that a bottoms-up system based on competition has a better chance of reining in Medicare costs than a top-down system based on expert opinion. As part of his argument he dredges up a couple of examples where Medicare experts have been wrong in the past. Fair enough, I guess. Sort of bush league, but a pretty common practice among opinion mongers.

Moreover, if 15 Washington-based experts really can save a system as vast as Medicare through a process of top-down control, then this will be the only realm of human endeavor where that sort of engineering actually works.

I know this is an applause line in certain circles, but really, what possesses people to say stuff like this? Top-down control has never worked in all of human history? Seriously? Is the Catholic Church a successful endeavor? How about the U.S. Army? Or the interstate highway system? Or every corporation in America? Corporations may be embedded within a larger competitive ecosystem, but almost universally they thrive within this system via top-down management structures. If you don't believe me, try working for a corporation.

Look: virtually every real-world instance of human organization works via some combination of top-down planning and bottoms-up competition. The pope is the unquestioned leader of the Catholic church, but in practice there are also lots of competing power centers within the church. Likewise, free market capitalism is primarily a system of aggregating individual preferences, but it works a lot better when there's some top-down planning to regulate the financial system and provide a predictable set of laws and property rights.

Medicare is no different. The basic structure is top-down, but plenty of liberal healthcare wonks favor introducing some aspects of competition. That's never really been the problem with Paul Ryan's Medicare proposal. Allowing beneficiaries to choose between competitive plans has plenty of supporters on both sides of the aisle, but on the liberal side we also want to make sure that funding remains strong enough to guarantee high-quality care that's affordable for everyone. Paul Ryan very decidedly doesn't care about that, and provides little more than handwaving when you ask him how his plan will work. That's what really sets the two sides apart.

The fact is that there's zero evidence from anywhere in the world that simply forcing seniors to pay a way bigger share of their Medicare bills will substantially rein in healthcare costs. (It would certainly rein in Medicare costs, almost by definition, but unless healthcare costs also come down it does it simply by denying care to lots of people.) There is, however, limited evidence that it might put modest downward pressure on costs. Likewise, there's little evidence that better planning and control can have a large and durable impact on healthcare costs, but there is plenty of evidence that it too can put modest downward pressure on costs. Put both together and we'll probably make some progress.1 Pretend dogmatically that either one by itself is a silver bullet and you're almost certainly guaranteeing future failure.

1Though, frankly, probably not all that much. I'm all in favor of attacking healthcare costs on multiple fronts, but I continue to believe that the fundamental reason healthcare costs keep going up all over the world is because that's what people in rich countries want to spend their increasing wealth on. When it gets expensive enough that we collectively don't think it's worth spending more — regardless of whether that collective decision is expressed via the market or the ballot box — costs will start to plateau.

We do not generally praise doctors who help dispatch their terminally ill patients, as Kevorkian repeatedly and unashamedly did. Even when death is inevitable and inevitably painful, it is not considered merciful to prescribe an overdose to a cancer victim against her will, or to gently smother a sleeping Alzheimer’s patient.

The difference, of course, is that Kevorkian’s clients asked for it. That free choice is what separates assisted suicide from murder, his defenders would insist.

What peculiar wording. Douthat makes it sound as if this defense of Kevorkian is some kind of transparently concocted subterfuge. But, yes, the fact that his clients asked for it is what makes assisted suicide different from murder. Even if you don't approve, this is a pretty natural distinction and an easy one to grasp.

So what's the objection to assisted suicide? This is where it gets weird. Douthat argues that it's a slippery slope: if terminally ill patients are allowed to kill themselves, what's to stop anyone else who wants to do it? Nothing, he says, as the example of Dignitas, a Swiss assisted suicide clinic, shows. And technically that's true: about a fifth of Dignitas's clients aren't terminally ill, but merely weary of life. But think about that number: it means that perhaps 200 weary people have used Dignitas's services over the past decade or so. That's something like 20 per year.

In other words, even after a decade in business, Dignitas almost certainly isn't doing anything to spur suicides and it hasn't created a tidal wave of people wanting to die. Like so many other things, it merely provides an additional option for the well off (Dignitas charges about $6,000 to perform an assisted suicide). The less well off simply continue to swallow bottles of aspirin or jump off bridges.

So, again: what's the problem?1 More than anything else, I think this column illustrates the perils of taking a religiously motivated belief and trying to justify it on secular grounds. It just doesn't work. The slippery slope here pretty obviously doesn't amount to much, so you're left with a simple disapproval of people deciding to take their own lives. And what's the argument for that? Douthat doesn't provide one. He simply declares it murder and calls it a day. Without recourse to his underlying religious objections, that's really his only choice.

But of course, that's the real slippery slope. If the state is allowed to prohibit me from killing myself, what else is the state allowed to do? Can it force me to accept medical treatment that will save my life? Can it force me to accept medical treatment that might save my life? If not, why?

I'm a liberal, but I'd just as soon keep the state out of decisions like that. I'd especially like to keep the state out if there's no compelling secular reason for them to get involved. In this case, there sure doesn't appear to be.

1Needless to say, there are practical issues with assisted suicide. You need to make sure the client really wants to die and isn't just reacting to a momentary bout of depression. You need to make sure there's no coercion. You need to make sure the client is of sound mind. But I think all of these things are pretty widely accepted as simple common sense.

President Obama's former top economic adviser is jumping on Friday's weak jobs numbers to make the case that the economy needs a much bigger boost from Washington than it's getting.

....What should Washington be doing? Romer called for additional fiscal stimulus, as part of a package that reduces the deficit over the long term. That spending, she said, should take the form of a cut in the employer side of the payroll tax--an idea with bipartisan appeal--as well as more aid to state and local governments. She also supports infrastructure spending of the kind President Obama has proposed.

We could do this if elite consensus in this country accepted that chronic massive unemployment was a bigger problem than our future federal deficit. But the former affects actual middle class people right now, while the latter — might, possibly — affect the financial fortunes of the well-off in the indefinite future. Looked at that way, it's a no brainer. Deficits it is.

Details on the size or beneficiaries of the projects funded by the MFET are hard to discern from the defense bill's lengthy list of procurements. But armed services committee members on both sides of the aisle have left clues. In the days following the voice vote approving their budget, they pumped out press releases trumpeting the projects they'd scored for their districts. Since the MFET funds came from other cuts in the Pentagon budget, the members could claim their projects would be offset by spending cuts elsewhere. Rep. Allen West (R-Fla.), a tea party freshman who sees himself as a budget hawk, secured $8 million for engines for Army drones, funded by savings from "wasteful DOD offsets." Rep. Chris Gibson (R-N.Y.) bragged that he'd secured a federal study to open a nanotechnology lab on the SUNY-Albany campus in his district, as well as $7 million in funding for additional nanotech research. Rep. Martin Heinrich (D-N.M.), announced $3 million in funding for a nonprofit called the Technology Ventures Corporation, which would "help expand innovation in New Mexico's emerging satellite industry."

Ah, Washington. Not only are these earmarks, despite some laughable attempts to suggest otherwise, but they're stealth earmarks that don't even have to be disclosed. This actually makes them worse than old style pork. It turns out you can take the boy out of the pig sty, but you can never take the pig sty out of the boy.

It would begin with a simple and predictable tax system, with a broad base and low rates, free of most of today's deductions and exclusions. The only three worth keeping in the individual tax code are the tax exemption for retirement savings (which are far preferable to universal cash benefits to retirees), a unified child tax credit (to encourage parenthood and to offset the mistreatment of parents in the tax code), and the charitable-giving deduction (since a reduction in government's role in social welfare must be met with an increase in the role of civil society, which should be encouraged). These three exemptions are directed precisely to the needs of a modern society, and to addressing the three broad failings of the social-democratic welfare state.

This really doesn't work. If you think, say, that the mortgage interest deduction is bad policy and we ought to get rid of it, that's fine. Make your case and push to get it repealed. Ditto for all the other tax expenditures in the tax code.

But what you really can't do is argue that deductions are inherently bad and we should get rid of them all — except for these two or three pet ideas that I really truly think are worth making an exception for. You either think that tax expenditures are distortionary and therefore bad policy in general, or you think that it depends on exactly which ones we're talking about and prefer to look at them on a case-by-case basis. After all, every tax expenditure in the current tax code is there because someone thought it encouraged some kind of worthwhile behavior that was directed to the needs of a modern society. If you insist that your three exceptions are worthy ones, then you have to accept that other people are going to find worthy exceptions too.

Personally, I'm in the "case by case" camp. It's always satisfying to take a hard line and demand that the tax code be pure, but human nature just doesn't seem to work that way. Everyone has behavior they believe should be encouraged or discouraged, and sometimes the tax code is the most efficient way of doing it. I'm happy with efforts to scrape barnacles away periodically, but there's no point in pretending that the hull is going to stay clean forever. And there's especially no point in doing it if you yourself have several pet barnacles of your own.

Jon Chait has a good post this morning about a Politico story that simply insists on finding some kind of Democratic counterpart to the gruesome and longstanding efforts of Republicans to make it harder for Democratic-leaning groups to vote. In Politico's defense, their stale attempt at faux evenhandedness only takes up two paragraphs, but the tone of the article throughout suggests that this battle is roughly equivalent on both sides, as if suppressing votes were pretty much the same thing as encouraging votes. You'd think we'd be past that by now, but apparently not.

“I don’t know why everybody’s so puzzled by this,” said Florida state Rep. Dennis Baxley, R-Ocala, sponsor of a controversial election-reform law there....Baxley said the lax address requirement opened the door to abuse, like a city council election he heard about in which the “pro-family” candidate was favored to win until his opponent, “a homosexual activist candidate,” bused in homosexuals from other parts of the state who showed up at the polls and claimed residency at an address occupied by a local Dunkin Donuts.

Chait cautiously says he "strongly" suspects that "the whole story is an exaggeration at best, and a pure fantasy at worst." I think I'll go with pure fantasy myself, even though I have no idea where this story comes from or what urban legend is behind it. This means some enterprising right winger has an opportunity to make me look like a knee-jerk liberal shill who's never willing to concede even the possibility that conservatives might be acting in good faith. All you have to do is find the wellspring of this story and demonstrate that there's something to it.

Anyone can play. I did a bit of desultory googling, but that's about all the time I can afford to spend on this right now. But I really am curious, in an academic sort of way. Has anyone ever heard this story before? Where did it come from? Is there even a remote grain of truth anywhere in it?